Models of Integration

Six Levels of Collaboration/Integration (Key Differentiators)

COORDINATED
Level 1
Minimal Collaboration
Level 2
Basic Collaboration at a Distance
Key Differentiator: Clinical Delivery
  • Screening and assessment done according to separate practice models
  • Separate treatment plans
  • Evidences-based practices (EBP) implemented separately
  • Screening based on separate practices; information may be shared through formal requests or Health Information Exchanges
  • Separate treatment plans shared based on established relationships between specific providers
  • Separate responsibility for care/EBPs
Key Differentiator: Patient Experience
  • Patient Physical and behavioral health needs are treated as separate issues
  • Patient must negotiate separate practices and sites on their own with varying degrees of success
  • Patient health needs are treated separately, but records are shared, promoting better provider knowledge
  • Patients may be referred, but a variety of barrier prevent many patients from accessing care
Key Differentiator: Practice/Organization
  • No coordination or management of collaboration efforts
  • Little provider buy-in to integration or even collaboration, up to individual providers to initiate as time and practice limits allow
  • Some practice leadership in more systematic information sharing
  • Some provider buy-into collaboration and value placed on having needed information
Key Differentiator: Business Model
  • Separate funding
  • No sharing of resources
  • Separate billing practices
  • Separate funding
  • May share resources for single projects
  • Separate billing practices

 

CO-LOCATED
Level 3
Basic Collaboration Onsite
Level 4
Close Collaboration Onsite with some System Integration
Key Differentiator: Clinical Delivery
  • May agree on a specific screening or other criteria for more effective in-house referral
  • Separate service plans with some shared information that informs them
  • Some shared knowledge of each other’s EBPs, Especially for high untilizers
  • Agree on specific screening, based on ability to respond to results
  • Collaborative treatment planning for specific patients
  • Some EBPs and some training shared, focused on interest or specific population needs
Key Differentiator: Patient Experience
  • Patient health needs are treated separately at the same location
  • Close proximity allows referrals to be more successful and easier for patients although who get referred may very by provider
  • Patient need are treated separately at the same site, collaboration might include warm hand-offs to other treatment providers
  • Patients are internally referred with better follow-up, but collaboration may still be experienced as separate services
Key Differentiator: Practice/Organization
  • Organization leaders supportive but often co-location is viewed as a project or program
  • Providoer buy-in to making referrals work and appreciation of onsite availability
  • Patient health needs are treated separately, but records are shared, promoting better provider knowledge
  • Patients may be referred, but a variety of barrier prevent many patients from accessing care
Key Differentiator: Business Model
  • Separate funding
  • May share facility expenses
  • Separate billing pratices
  • Separate funding, but may share grants
  • May share office expenses, staffing costs, or infrastructure
  • Separate billing due to system barriers

 

INTEGRATED
Level 5
Close Collaboration Approaching an Integrated Practice
Level 6
Full collaboration in a Transformed/Merged Integrated Practice
Key Differentiator: Clinical Delivery
  • Consistent set of agreed upon screening across disciplines, which guide treatment interventions
  • Collaborative treatment planning for all shared patients
  • EBPs shared across system with some joint Monitoring of health conditions for some patients
  • Population-based medical and behavioral health screening is standard practice with results available to all and response protocols in place
  • One treatment plan for all patients
  • EBPs are team selected, trained and implemented across disciplines as standard practice
Key Differentiator: Patient Experience
  • Patient needs are treated as a team for shared patients (for those who screen positive on screening measures) and saparately for others
  • Care is responsive to identified patient needs by a team of providers as needed which feels like a one-stop shop
  • All Patient health needs are treated for all patients by a team, who function effectively together
  • Patients experience a seamless response to all healthcare needs as they present, in a unified practice
Key Differentiator: Practice/Organization
  • Organization leaders support integration, if funding allows and efforts placed in solving as many system issues as possible, without changing fundamentally how desciplines are practiced
  • Nearly all provider engaged in integrated model. Buy-in may not include change in practice strategy for individual providers
  • Organization leaders strongly support integration as practice model with expected change in service delivery, and resources provided for development
  • Integrated care and all components embraced by all providers and active involvement in practice change
Key Differentiator: Business Model
  • Blended funding based on contracts, grants or agreements
  • Variety of ways to structure the sharing of all expenses
  • Billing function combined or agreed upon process
  • Integrated funding, based on multiple sources of revenue resources shared and allocated across whole practice
  • Billing maximized for integrated model and single billing structure